Xenopericardial roll graft replacement for infectious pseudoaneurysms and graft infections of the aorta

Journal of Cardiothoracic Surgery

Kenichi Sudo⁴  Hideaki Yoshino²  Osamu Yanagida³  Eri Kondo⁶  Gen Nagao⁶  Hirohisa Takeuchi⁶  Nobutsugu Abe⁶  Masanori Sugiyama⁶  Mitsuru Matsukura¹  Yoko Nemoto¹  Yoshihisa Makino¹  Masaru Nemoto¹  Tooru Ikezoe⁵  Yutaka Hosoi⁵  Masao Nunokawa⁵  Yoshifumi Nishino⁵  Yusuke Inaba⁵  Yu Takahashi⁵  Akihiro Yoshimoto⁵  Hiroshi Tsuchiya⁵  Hikaru Ishii⁵  Mio Noma⁵  Hidehito Endo⁵  Hiroshi Kubota⁵ 

[1] Department of Vascular Surgery, Tokyo University, Tokyo, Japan;Department of Cardiology, Kyorin University, Tokyo, Japan;Kosei General Hospital affiliated to Rissho Kosei-Kai, Tokyo, Japan;Jiseikai Nomura Hospital, Tokyo, Japan;Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka 181-8611, Tokyo, Japan;Department of Gastroenterological Surgery, Kyorin University, Tokyo, Japan

关键词: Bovine pericardium;    Equine pericardium;    Xenograft;    Graft infection;    Infection;    Esophageal perforation;    Esophageal injury;    Biomaterials;    Pseudoaneurysm;    Aortic operation;   

Others  :  1232329
DOI  :  10.1186/s13019-015-0343-5

 received in 2015-02-23, accepted in 2015-10-26,  发布年份 2015

【 摘 要 】

Background

Which graft material is the optimal graft material for the treatment of infected aortic aneurysms and aortic graft infections is still a matter of controversy. Orthotopic aortic reconstruction with intraoperatively prepared xenopericardial roll grafts without omentopexy was performed as the “initial” operation to treat aortic infection or as a “rescue” operation to treat graft infection. Mid-term outcomes were evaluated.

Methods

Between 2009 and 2013, orthotopic xenopericardial roll graft replacement was performed to treat eight patients (male/female: 6/2; mean age: 69.5 [55–80] yr). Graft material: equine/bovine pericardium: 2/6; type of operation: initial 4/rescue 4; omentopexy 0. Additional operation: esophagectomy 2. Mean follow-up period: 2.6 ± 1.6 (1.1–5.1) years.

Results

Replacement: ascending 3, arch 1 (reconstruction of neck vessels with small xenopericardial roll grafts), descending 3, and thoracoabdominal 1. Pathogens: MRSA 2, MSSA 1, Candida 1, E. coli 1, oral bacillus 1, and culture negative 2. Postoperative local recurrence of infection: 0. Graft-related complications: stenosis 0, calcification 0, non-infectious pseudoaneurysm of anastomosis 2 (surgical repair: 1/TEVAR 1). In-hospital mortality: 2 (MOF: initial 1/rescue 1); Survival rate exclusive of in-hospital deaths (~3 y): 100 %, but one patient died of lung cancer (3.6 yr).

Conclusions

Because xenopericardial roll grafts are not composed of synthetic material, the replacement procedure is simpler and less invasive than the standard procedure. Based on the favorable results obtained, this procedure may have the possibility to serve as an option for the treatment of aortic infections and aortic graft infections not only as a “rescue” treatment but as an “initial” treatment as well.

【 授权许可】

   
2015 Kubota et al.

【 图 表 】

Figure 5.

Fig. 2.

Fig. 3.

Fig. 4.

Fig. 5.

Fig. 6.

【 参考文献 】

• [1]Kubota H, Takamoto S, Yoshino H, Kitahori K, Kawata M, Tonari K et al.. Clinical application of intermittent pressure-augmented retrograde cerebral perfusion. Ann Thorac Surg. 2010; 90:1340-3.
• [2]Kubota H, Tonari K, Endo H, Tsuchiya H, Yoshino H, Sudo K. Total Aortic Arch Replacement under Intermittent Pressure-augmented Retrograde Cerebral Perfusion. J Cardiothorac Surg. 2010; 5:97. BioMed Central Full Text
• [3]Kitahori K, Takamoto S, Takayama H, Suematsu Y, Ono M, Motomura N et al.. A novel protocol of retrograde cerebral perfusion with intermittent pressure augmentation for brain protection. J Torac Cardiovasc Surg. 2005; 130:363-70.
• [4]Kawata M, Takamoto S, Kitahori K, Tsukihara H, Morota T, Ono M et al.. Intermittent pressure augmentation during retrograde cerebral perfusion under moderate hypothermia provides adequate neuroprotection: An experimental study. J Thorac Cardiovasc Surg. 2006; 132:80-8.
• [5]Endo H, Kubota H, Tsuchiya H, Yoshimoto A, Takahashi Y, Inaba Y et al.. Clinical efficacy of intermittent pressure augmented–retrograde cerebral perfusion. J Thorac Cardiovasc Surg. 2013; 145:768-73.
• [6]Kubota H, Endo H, Noma M, Tsuchiya H, Yoshimoto A, Takahashi Y et al.. Equine pericardial roll graft replacement of infected pseudoaneurysm of the ascending aorta. J Cardiothorac Surg. 2012; 7:54. BioMed Central Full Text
• [7]Tremblay D, Zigras T, Cartier R, Leduc L, Butany J, Mongrain R et al.. A comparison of mechanical properties of materials used in aortic arch reconstruction. Ann Thorac Surg. 2009; 88:1484-91.
• [8]Kubota H, Endo H, Noma M, Tsuchiya H, Yoshimoto A, Matsukura M et al.. Equine pericardial roll graft replacement of infected pseudoaneurysm of the aortic arch. J Cardiothorac Surg. 2012; 7:45. BioMed Central Full Text
• [9]Vogt P, von Segesser L, Goffin Y, Pasic M, Turina M. Cryopreserved arterial homografts for in situ reconstruction of mycotic aneurysms and prosthetic graft infection. Eur J Cardiothorac Surg. 1995; 9:502-6.
• [10]Vogt P, Pasic M, von Segesser L, Carrel T, Turina M. Cryopreserved aortic homograft for mycotic aneurysms. J Thorac Cardiovasc Surg. 1995; 109:589-91.
• [11]Gupta A, Bandyk D, Johnson B. In situ repair of mycotic abdominal aortic aneurysms with rifampicin-bonded gelatin-impregnated Dacron grafts. J Vasc Surg. 1996; 24:472-6.
• [12]Miyamoto S, Hadama T, Tanaka H, Anai H, Sako H, Wada T et al.. MRSA aortic valve endocarditis treated by pericardium-lined Dacron patch and vancomycin-containing fibrin glue. Ann Thorac Cardiovasc Surg. 2004; 10:252-4.
• [13]Braile DM, Ardito RV, Greco OT. Alargamento da raiz da aorta com ‘patch’ de paricardio bovino preservado pelo glutaraldehido. Arq Bras Cardiol. 1983; 41:289-96.
• [14]Ardito RV, Santos JLV, Mayorquim RC, Greco OT, Zaiantchic M, Soto HG et al.. Substituicao complete da aorta ascendente e da valve aortica com tubo valvulado de pericardio bovino. Rev Bras Cir Cardiovasc. 1987; 2:129-38.
• [15]Puig LB, Casagrande IS, Kalil RA, Salles CA, Moreira MCV, Borem PM et al.. Early experience with crimped bovine pericardial conduit for arterial reconstruction. Eur J Cardiothorac Surg. 1991; 5:273-9.
• [16]Salles CA, Puig LB, Casagrande IS, Vieira GL, Kalil RA, Souza LSS et al.. Aortic reconstruction with crimped bovine pericardial conduits. J Heart Valve Dis. 1998; 7(3):305-312.
• [17]Gontijo B, Vrandecic M, Fantini F, Silva J, Barbosa JT, Ferrufino AB et al.. Replacement of the ascending aorta and aortic arch with bovine pericardial grafts - a preliminary report. Eur J Cardiothorac Surg. 1995; 9:127-32.
• [18]Scott EM, Gorman SP. Glutaraldehyde. In: Disinfection, sterilization, and prevention. 4th ed. Block SS, editor. Lea & Febiger, Philadelphia; 1991: p.596-614.
• [19]Vaudaux PE, Lew DP, Waldvogel FA. Host factors predisposing to and influencing therapy of foreign body infections associated with indwelling medical devices. 2nd ed. American Society for Microbiology, Washington, D.C.; 1994.
• [20]Yamamoto H, Yamamoto F, Ishibashi K, Motokawa M. In situ replacement with equine pericardial roll grafts for ruptured infected aneurysms of the abdominal aorta. J Vasc Surg. 2009; 49:1041-5.
• [21]Yamamoto H, Yamamoto F, Ishibashi K, Chiba Y, Minamiya Y, Nanji H. In situ replacement of the thoracic aorta using an equine pericardial roll graft for an aortobronchial fistula due to aortic rupture. Gen Thorac Cardiovasc Surg. 2009; 57:413-7.
• [22]Czerny M, Allmen R, Opfermann P, Sodeck G, Dick F, Stellmes A et al.. Self-made pericardial tube graft: a new surgical concept for treatment of graft infections after thoracic and abdominal aortic procedures. Ann Thorac Surg. 2011; 92:1657-62.
• [23]Yamamoto H, Yamamoto F, Tanaka F, Nishikawa Y. Vulnerability of an equine pericardial roll graft to gram-positive cocci after graft replacement for a ruptured infected abdominal aorta. Interact Cardiovasc Thorac Surg. 2011; 12:866-8.
• [24]McMillanW LCD, Hile CN. Bovine pericardial patch repair in infected fields. J Vasc Surg. 2012; 55:1712-5.
• [25]Ho KJ, Nguyen LL, Menard MT. Intermediate-term outcome of carotid endarterectomy with bovine pericardial patch closure compared with Dacron patch and primary closure. J Vasc Surg. 2012; 55:708-14.
• [26]Kurobe H, Maxfield MW, Breuer CK, Shinoka T. Tissue-engineered vascular grafts for cardiac surgery: past, present, and future. Stem Cells Transl Med. 2012; 1:566-7.